Wednesday, April 11, 2012

City Dwellers Are From Mars, Rural Dwellers Are From Venus, Or Something Like That

Despite the monstrous quantities of 'unsafe' sex that Africans are claimed to engage in by UNAIDS and other HIV institutions, HIV is not at all distributed evenly. Prevalence ranges from less than 1% in some African countries, a lot less than in some US cities, to more than 25% of the adult population in others (and even 50% in some demographic groups). Even within high prevalence countries HIV is not distributed evenly. In many African countries the virus tends to be far more common in cities, close to main roads, close to health facilities, among wealthier and better educated people, etc. It is also generally far more common among women than among men.

Other research has found HIV prevalence to be higher in areas where diseases such as schistosomiasis (bilharzia) and malaria are higher. However, as these both tend to be higher among less wealthy people with lower levels of education and in rural, as opposed to urban areas, there is more than a suggestion that HIV transmission may have widely varying risk factors. Yet UNAIDS and friends tend not to dwell on most forms of non-sexual risk in Africa.

As David Gisselquist writes in the Don't Get Stuck With HIV website: "Unlike Western countries, where almost all HIV transmission occurs outside families, a lot of HIV transmission in Africa happens within families – mother-to-child and spouse-to-spouse transmission together account for an estimated 45% of new infections." Not only is a lot of HIV not transmitted sexually, but a lot is not transmitted through 'unsafe' sex. Many of these couples where at least one partner is infected have no sexual risks. Hundreds of thousands of new infections every year occur through these two routes.

In Africa, then, the main groups are those at risk of mother to child transmission and married couples, especially couples where one partner has been infected. It's as likely to be the female as the male partner, but how does the index partner become infected, the first in the couple? Sex, says UNAIDS, but sex with whom, how much sex and what kind of sex? Heterosexual sex is not an efficient means of transmitting HIV. Gisselquist is suggesting that the focus of international HIV reduction efforts in African countries should address these and other risk groups, where sexual risk is very likely to be low but HIV prevalence is high; this could cut as many as 700,000 transmissions annually.

A serious set of risk factors could arise from unsafe healthcare and perhaps even unsafe cosmetic services. It's not just that conditions in healthcare and cosmetic facilities in African countries are primitive but also that many people are not aware that such risks exist; if they are not aware of the risks, they will not know that they need to avoid them, nor how to avoid them. But if they are aware, they will also realize that a person's HIV status is not a reliable indication of their sexual behavior. This should reassure some who have been brainwashed to associate HIV with 'immoral' behavior; many women, especially, have been beaten by their partners, ostracized by their communities and even killed because of the incorrect association of HIV with sexual behavior.

The HIV industry does talk a lot about the importance of HIV testing. But they also put people off testing where being positive has such terrible consequences. If people were to know that there were other, non-sexual risks, the stigma associated with testing and with having (or being thought to have) HIV should reduce. People who know their status don't tend to take risks, neither sexual nor non-sexual; but they must also be advised of the non-sexual risks. Those who are infected non-sexually can be involved in sexual transmission just as easily as those who are infected sexually. But in the current climate of sex-obsessed HIV policies, they are unlikely to know about non-sexual risk.

Prevention of mother to child HIV transmission is vital if the mother is already infected. But more effort needs to be made to ensure that mothers are not infected in the first place. A lot of pregnant mothers who are HIV positive have HIV negative partners. How did the mothers become infected? Often they seroconverted well into their pregnancy, or even some time after delivery. As the chances that all women in this position engaged in 'unsafe' sex are low (except in the minds of those who think most Africans engage in 'unsafe' sex most of the time), their non-sexual risks also need to be examined. Why wait till the mother is infected with HIV before intervening to protect her child if the mother could be protected first, obviating the need to protect her child?

In Western countries it's not so likely that HIV will infect several members in the same family, being mainly transmitted through male to male anal sex and sharing needles during intravenous drug use. But, as well as clustering in various demographics and in those close to cities, roads and health facilities, HIV in African countries frequently infects more than one person in the same family. Sometimes, infants and very young children are found to be infected when their mother is not. Others who have no identifiable sexual risks are found to be infected... UNAIDS says 80-90% of transmissions are through heterosexual sex, but this claim is not supported by evidence.

There's little point in looking for a sexual risk, or worse, assuming a sexual risk, when many HIV positive people may not have been infected sexually. And there is no need to impute 'unsafe' sexual behavior to people solely on the grounds that they are HIV positive, which can result in persecution and stigma, even injury and death. Even if non-sexual risks play a relatively small role in serious HIV epidemics, we need to know the relative contribution of both sexual and non-sexual risks if we hope to eradicate transmission altogether. At the rate we are going, we could be missing an awful lot of opportunities to reduce HIV transmission and to eventually eradicate the virus.

[For more about non-sexual HIV transmission and how to avoid it, see the Don't Get Stuck With HIV site.]


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